Tuberculosis remains one of the major causes of morbidity and mortality in Equatorial Guinea, with an estimated incidence of 280 per 100,000 inhabitants, an estimated mortality rate of 96 per 100,000 inhabitants, and a treatment non-adherence rate of 21.4%. This study aimed to identify the factors associated to TB-related knowledge, attitudes, and stigma in order to design community intervention strategies that could improve TB diagnostic and treatment adherence in Equatorial Guinea. A nationwide cross-sectional survey of 770 household caregivers was conducted in Equatorial Guinea about TB knowledge, attitudes, and practices. Knowledge, attitude, and stigma scores were calculated through correct answers and the median was used as cut-off. Associated factors were analyzed calculating prevalence ratio (PR) and a 95% confidence interval (95% CI) through Poisson regression with robust variance. The percentage of women was 53.0% and median age was 46 years (IQR: 33–60). The percentage of caregivers with high TB related knowledge was 34.9%, with a bad attitude (52.5%) and low stigma (40.4%). A greater probability of having good knowledge was observed in those 45 years old or less (PR: 1.3, 95% CI: 1.1–1.6), those with higher education level (PR: 1.4, 95% CI: 1.1–1.8) and higher wealth (PR: 1.4, 95% CI: 1.0–2.0), while sex (PR = 0.8, 95% CI: 0.6–0.9), religion (PR = 1.4, 95% CI: 1.0–1.8), and good knowledge (PR = 1.4, 95% CI: 1.2–1.7) were associated with good attitudes. Wage employment (PR = 95% CI: 1.2–1.4), feeling well informed (PR = 0.7, 95% CI: 0.6–0.8), having good TB knowledge (PR = 1.3, 95% CI: 1.1–1.7), and some sources of information were associated with having lower TB-related stigma. This study found that a high percentage of caregivers in Equatorial Guinea lack important knowledge about TB disease and have bad attitudes and high TB-related stigma. Given the epidemiological situation of TB in the country, it is urgent to improve TB knowledge and awareness among Equatorial Guinea’s general population.

Loiasis, caused by the filarial nematode Loa loa, is endemic in Central and West Africa. Loa loa has been associated with severe adverse reactions in high Loa-infected individuals receiving ivermectin during mass drug administration programs for the control of onchocerciasis and lymphatic filariasis. Diagnosis of loiasis still depends on microscopy in blood samples, but this is not effective for large-scale surveys. New diagnostics methods for loiasis are urgently needed. Previously, we developed a colorimetric high-sensitive and species-specific LAMP for Loa loa DNA detection. Here, we evaluate it in a set of 100 field-collected clinical samples stored as dried blood spots. In addition, Loa loa-LAMP was also evaluated in real-time testing and compared with microscopy and a specific PCR/nested PCR. A simple saponin/Chelex-based method was used to extract DNA. Colorimetric and real-time LAMP assays detected more samples with microscopy-confirmed Loa loa and Loa loa/Mansonella perstans mixed infections than PCR/nested-PCR. Samples with the highest Loa loa microfilariae counts were amplified faster in real-time LAMP assays. Our Loa loa-LAMP could be a promising molecular tool for the easy, rapid and accurate screening of patients for loiasis in endemic areas with low-resource settings. The real-time testing (feasible in a handheld device) could be very useful to rule out high-microfilariae loads in infected patients.

A lack of HIV viral load (VL) and HIV drug resistance (HIVDR) monitoring in sub-Saharan Africa has led to an uncontrolled circulation of HIV-strains with drug resistance mutations (DRM), compromising antiretroviral therapy (ART). This study updates HIVDR data and HIV-1 variants in Equatorial Guinea (EG), providing the first data on children/adolescents in the country. From 2019–2020, 269 dried blood samples (DBS) were collected in Bata Regional Hospital (EG) from 187 adults (73 ART-naïve/114 ART-treated) and 82 children/adolescents (25 HIV-exposed-ART-naïve/57 ART-treated). HIV-1 infection was confirmed in Madrid by molecular/serological confirmatory tests and ART-failure by VL quantification. HIV-1 pol region was identified as transmitted/acquired DRM, predicted antiretroviral susceptibility (Stanfordv9.0) and HIV-1 variants (phylogeny). HIV infection was confirmed in 88.1% of the individuals and virological failure (VL > 1000 HIV-1-RNA copies/mL) in 84.2/88.9/61.9% of 169 ART-treated children/adolescents/adults. Among the 167 subjects with available data, 24.6% suffered a diagnostic delay. All 125 treated had experienced nucleoside retrotranscriptase inhibitors (NRTI); 95.2% were non-NRTI (NNRTI); 22.4% had experienced integrase inhibitors (INSTI); and 16% had experienced protease inhibitors (PI). At sampling, they had received 1 (37.6%), 2 (32%), 3 (24.8%) or 4 (5.6%) different ART-regimens. Among the 43 treated children–adolescents/37 adults with sequence, 62.8/64.9% carried viruses with major-DRM. Most harbored DRM to NNRTI (68.4/66.7%), NRTI (55.3/43.3%) or NRTI+NNRTI (50/33.3%). One adult and one child carried major-DRM to PI and none carried major-DRM to INSTI. Most participants were susceptible to INI and PI. DRM was absent in 36.2% of treated patients with VL > 1000 cp/mL, suggesting adherence failure. TDR prevalence in 59 ART-naïve adults was high (20.3%). One-half (53.9%) of the 141 subjects with pol sequence carried CRF02_AG. The observed high rate of ART-failure and transmitted/acquired HIVDR could compromise the 95-95-95-UNAIDS targets in EG. Routine VL and resistance monitoring implementation are mandatory for early detection of ART-failure and optimal rescue therapy selection ART regimens based on PI, and INSTI can improve HIV control in EG.

Background: Onchocerciasis, or river blindness, is one of the neglected tropical diseases (NTDs) that the WHO has set out to eliminate. To reach this elimination target, a number of challenges must be met, and the essential measures set out in the road map for NTDs 2021–2030 must be implemented. More than 99% of infected people live in 31 countries in sub-Saharan Africa. Our objective was to assess the impact of onchocerciasis interventions in Africa. Methodology: A systematic peer review of the existing literature following the PRISMA guidelines was performed between November 2021 and April 2022. We selected studies on onchocerciasis control measures in Africa since the implementation of the first Onchocerciasis Control Programme (OCP) measures in 1974. All scientific articles indexed in the PubMed, Scopus, Embase, and CENTRAL databases written in Spanish, English, French, German, and Portuguese were considered. The study protocol was registered in the PROSPERO database. Results: A total of 63 articles met the inclusion criteria and were finally selected. Publications were found from 19 out of 31 African endemic countries. The main intervention retained in the different published studies was mass distribution of ivermectin (n = 51). According to our results, 11 African countries have managed to interrupt transmission of onchocerciasis in at least one area in the country; 11 countries have not achieved this goal, while 1 country has managed to eliminate the disease, but it has resurged. Conclusions: Control interventions showed a positive impact on the fight against onchocerciasis, demonstrating that these activities are effective. Nevertheless, they were not sufficient to achieve the proposed goals for a variety of reasons. Therefore, different aspects should be considered in order to fulfil the targets proposed by the WHO to be reached in 2030.

Background In Equatorial Guinea, only 54 % of people living with HIV know their HIV status. There are no confirmatory or molecular diagnostic techniques for early diagnosis or monitoring of infection in the country. Rapid diagnostic tests can induce false-positive diagnoses if used as a confirmatory technique. Our study aimed to identify the challenges of early HIV diagnosis in Equatorial Guinea by analyzing the rate of false positive diagnoses, diagnostic and therapeutic delays, and treatment failures among those on antiretroviral therapy. Methods From 2019-2022, dried blood from 341 children, adolescents and adults diagnosed in Equatorial Guinea as HIV-positive by rapid diagnostic testing, and from 54 HIV-exposed infants were collected in Bata and sent to Madrid to confirm HIV-infection by molecular (Xpert HIV-1Qual, Cepheid) and/or serological confirmatory assays (Geenius-HIV-1/2, BioRad). HIV diagnostic delay (CD4 <350cells/mm(3)), advanced disease at diagnosis (CD4 1,000RNA-HIV-1-copies/ml) were also studied after viral quantification (XpertVL HIV-1, Cepheid). Results False-positive diagnoses were identified in 5 % of analysed samples. HIV infection was confirmed in 90.5 % of previously diagnosed patients in Equatorial Guinea and 3.7 % of HIV-exposed children undiagnosed in the field. Two-thirds of each new HIV patient had delayed diagnosis, and one-third had advanced disease. Treatment delay occurred in 28.3 % of patients, being around four times more likely in adolescents/adults than children. More than half (56 %) of 232 treated patients presented treatment failure, being significantly higher in children/adolescents than in adults (82.9 %/90 % vs. 45.6 %, p < 0.001). Conclusion We identified some challenges of early HIV diagnosis in Equatorial Guinea, revealing a high rate of false positive diagnoses, diagnostic/treatment delays, and treatment failures that need to be addressed. The implementation of more accurate rapid diagnostic techniques and confirmatory tests, along with improving access to care, treatment, awareness, and screening, would contribute to controlling the spread of HIV in the country.(c) 2024 The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background/Objectives: The impact of COVID-19 in Africa has been controversial. Data from African countries are heterogeneous and generally scarce. Many regions are also highly endemic for other infectious diseases like malaria, and it has been suggested that the low incidence and mortality of COVID-19 in malaria-endemic regions could have been related to cross-immunity between malaria and SARS-CoV-2. The aim of this study was to determine the prevalence of SARS-CoV-2 and circulating variants as well as the frequency of co-infections with malaria in Equatorial Guinea. Methods: We conducted antigen tests for SARS-CoV-2 and microscopy malaria examinations in 1556 volunteer participants at six health centres in Bioko and Bata from June to October 2021 and performed SARS-CoV-2 whole-genome sequencing on positive samples to determine the diversity and origin of circulating variants. Results: We report 3.03% of SARS-CoV-2 and 22.25% of malaria prevalence over the sampling period; SARS-CoV-2 cases were found at a similar frequency in all age groups, whereas malaria was most frequent in children and teenagers. Six cases of malaria and SARS-CoV-2 co-infection were found, representing 0.37% prevalence. Genome sequences of 43 SARS-CoV-2 isolates are reported, most of which belong to the lineage Delta and, according to pandemic-scale phylogenies, were introduced from Europe on multiple occasions. Conclusions: This study is relevant in providing first-time estimates of the real prevalence of SARS-CoV-2 in this malaria-endemic country, with the identification of circulating variants, their origin, and co-occurrence with malaria. These data regarding the impact of the pandemic and co-infection with endemic diseases are relevant in future pandemics preparedness.